Non-surgical methods for the treatment and prevention of skin scars

Hypertrophic scars and keloids mostly develop as a result of wound healing and skin burns. Depending on their location, pathological scars can be not only aesthetically distressing, but also present challenges associated with limited function of the limbs, frequent trauma, inflammation, and persistent pain syndrome. The urgency of the problem of hypertrophic and keloid scars has led to a plethora of therapeutic strategies and innovation techniques to prevent or attenuate pathological scar formation. At the same time, preventing pathological scarring is undoubtedly more effective and cheaper than treating it later on. Next to surgical techniques, injection therapy and an appropriate general postsurgical care for fresh wounds, a multitude of topical drugs are now available for scareless wound healing. Parallel to various silicone-based products, onion extract or cepalin has been highlighted as one of the potential anti-scarring agents over recent years. Based on several studies, onion extract alone or in combination with allantoin and heparin helped to alleviate the woundhealing process in wounds of various origins and prevent their pathological scarring. Considering that hypotrophic scar and keloid formation following surgery or trauma is almost impossible to predict, it is advisable to actively use topical dosage forms to improve wound healing and minimize aesthetic defect, the more so as the prevention of pathological scarring is more effective, safe and comfortable than its treatment. The simplicity of their use opens up vast opportunities for the treatment and prevention of the pathological scar formation in outpatient practice.

1. Broughton G. II, Janis J.E., Attinger C.E. The basic science of wound healing. Plast Reconstr Surg. 2006;117(7):12S-34S. https://doi.org/10.1097/01.prs.0000225430.42531.c2.

2. Janis J.E., Kwon R.K., Lalonde D.H. A practical guide to wound healing. Plast Reconstr Surg. 2010;125(6):230e-244e. https://doi.org/10.1097/PRS.0b013e3181d9a0d1.

3. Dunkin C.S., Pleat J.M., Gillespie P.H., Tyler M.P., Roberts A.H., McGrouther D.A. Scarring occurs at a critical depth of skin injury: precise measurement in a graduated dermal scratch in human volunteers. Plast Reconstr Surg. 2007;119(6):1722–1732. https://doi.org/10.1097/01.prs.0000258829.07399.f0.

4. Mustoe T.A., Cooter R.D., Gold M.H., Hobbs F.D., Ramelet A.A., Shakespeare P.G. et al. International clinical recommendations on scar management. Plast Reconstr Surg. 2002;110(2):560–571. https://doi.org/10.1097/00006534-200208000-00031.

5. Mutalik S. Treatment of keloids and hypertrophic scars. Indian J Dermatol Venerol Leprol. 2005;71(1):3–8. Available at: https://pubmed.ncbi.nlm.nih.gov/16394352.

6. Peacock E.E. Jr., Madden J.W., Trier W.C. Biologic basis for the treatment of keloids and hypertrophic scars. South Med J. 1970;63(7):755–760. Available at: https://pubmed.ncbi.nlm.nih.gov/5427162.

7. Lee J.Y., Yang C.C., Chao S.C., Wong T.W. Histopathological differential diagnosis of keloid and hypertrophic scar. Am J Dermatopathol. 2004;26(5):379–384. https://doi.org/10.1097/00000372-200410000-00006.

8. Al-Attar A., Mess S., Thomassen J.M., Kauffman C.L., Davison S.P. Keloid pathogenesis and treatment. Plast Reconstr Surg. 2006;117(1):286–300. https://doi.org/10.1097/01.prs.0000195073.73580.46.

9. Butler P.D., Longaker M.T., Yang G.P. Current progress in keloid research and treatment. J Am Coll Surg. 2008;206(4):731–741. https://doi.org/10.1016/j.jamcollsurg.2007.12.001.

10. Junker J.P., Kratz C., Tollback A., Kratz G. Mechanical tension stimulates the transdifferentiation of fibroblasts into myofibroblasts in human burn scars. Burns. 2008;34(7):942–946. https://doi.org/10.1016/j.burns.2008.01.010.

11. Kose O., Waseem A. Keloids and hypertrophic scars: are they two different sides of the same coin? Dermatol Surg. 2008;34(3):336– 346. https://doi.org/10.1111/j.1524-4725.2007.34067.x.

12. Shih B., Bayat A. Genetics of keloid scarring. Arch Dermatol Res. 2010;302(5):319–339. https://doi.org/10.1007/s00403-009-1014-y.

13. Willital G.H., Heine H. Efficacy of Contractubex gel in the treatment of fresh scars after thoracic surgery in children and adolescents. Int J Clin Pharmacol Res. 1994;14(5-6):193–202. Available at: https://pubmed.ncbi.nlm.nih.gov/7672876.

14. Sidgwick G.P., McGeorge D., Bayat A. A comprehensive evidencebased review on the role of topicals and dressings in the management of skin scarring. Arch Dermatol Res. 2015;307(6):461– 477. https://doi.org/10.1007/s00403-015-1572-0.

15. Phan T.T., Lee S.T., Sun L., Lim I.J., Chan S.Y., Bay B.H., Tan E.K. Quercetin inhibits fibronectin production by keloid-derived fibroblasts. Implication for the treatment of excessive scars. J Dermatol Sci. 2003;33(3):192–194. https://doi.org/10.1016/j.jdermsci.2003.08.008.

16. Phan T.T., Lim I.J., Chan S.Y., Tan E.K., Lee S.T., Longaker M.T. Suppression of transforming growth factor beta/smad signaling in keloid-derived fibroblasts by quercetin: implications for the treatment of excessive scars. J Trauma. 2004;57(5):1032–1037. https://doi.org/10.1097/01.ta.0000114087.46566.eb.

17. Willital G.H., Simon J. Efficacy of early initiation of a gel containing extractum cepae, heparin, and allantoin for scar treatment: an observational, noninterventional study of daily practice. J Drugs Dermatol. 2013;12(1):38–42. Available at: https://pubmed.ncbi.nlm.nih.gov/23377326.

18. Maragakis M., Willital G.H., Michel G., Gortelmeyer R. Possibilities of scar treatment after thoracic surgery. Drugs Exp Clin Res. 1995;21(5):199–206. Available at: https://pubmed.ncbi.nlm.nih.gov/8846750.

19. Chung V.Q., Kelley L., Marra D., Jiang S.B. Onion extract gel versus petrolatum emollient on new surgical scars: prospective doubleblinded study. Dermatol Surg. 2006;32(2):193–197. https://doi.org/10.1111/j.1524-4725.2006.32045.x.

20. Koc E., Arca E., Surucu B., Kurumlu Z. An open, randomized, controlled, comparative study of the combined effect of intralesional triamcinolone acetonide and onion extract gel and intralesional triamcinolone acetonide alone in the treatment of hypertrophic scars and keloids. Dermatol Surg. 2008;34(11):1507– 1514. https://doi.org/10.1111/j.1524-4725.2008.34314.x.

21. Ho W.S., Ying S.Y., Chan P.C., Chan H.H. Use of onion extract, heparin, allantoin gel in prevention of scarring in chinese patients having laser removal of tattoos: a prospective randomized controlled trial. Dermatol Surg. 2006;32(7):891–896. Available at: https://pubmed.ncbi.nlm.nih.gov/16875470.

22. Prager W., Gauglitz G.G. Effectiveness and safety of an overnight patch containing Allium cepa extract and Allantoin for postdermatologic surgery scars. Aesthet Plast Surg. 2018;42(4):1144– 1150. https://doi.org/10.1007/s00266-018-1172-4.

23. Vladimirova O.V., Lavreshin P.M., Minayev S.V., Vladimirov V.I. The experience of application of antiscar combined agent with boswellic and hyaluronic acids and cepalin in patients with scars at early stages of their development. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia). 2019;(1-2):140–145. (In Russ.) https://doi.org/10.21518/1995-1477-2019-1-2-140-145.